The Florida Clinical Skills Collaborative: A New Regional Consortium for the Assessment of Clinical Skills.

Discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Performance Evaluation (2-PE) raised questions about the ability of medical schools to ensure the clinical skills competence of graduating students. In February 2021, representatives from all Florida, United States, allopathic and osteopathic schools initiated a collaboration to address this critically important issue in the evolving landscape of medical education. A 5-point Likert scale survey of all members (n=18/20 individuals representing 10/10 institutions) reveals that initial interest in joining the collaboration was high among both individuals (mean 4.78, SD 0.43) and institutions (mean 4.69, SD 0.48). Most individuals (mean 4.78, SD 0.55) and institutions (mean 4.53, SD 0.72) are highly satisfied with their decision to join. Members most commonly cited a "desire to establish a shared assessment in place of Step 2 CS/2-PE" as their most important reason for joining. Experienced benefits of membership were ranked as the following: 1) Networking, 2) Shared resources for curriculum implementation, 3) Scholarship, and 4) Work towards a shared assessment in place of Step 2 CS/2-PE. Challenges of membership were ranked as the following: 1) Logistics such as scheduling and technology, 2) Agreement on common goals, 3) Total time commitment, and 4) Large group size. Members cited the "administration of a joint assessment pilot" as the highest priority for the coming year. Florida has successfully launched a regional consortium for the assessment of clinical skills competency with high levels of member satisfaction which may serve as a model for future regional consortia.

Family presence in Canadian PICUs during the COVID-19 pandemic: a mixed-methods environmental scan of policy and practice.

BACKGROUND: Despite their broad commitment to family-centred care, children's hospitals and associated pediatric intensive care units (PICUs) restricted family presence during the COVID-19 pandemic. This study aimed to describe family presence policies and practices in Canadian PICUs from March to May 2020, and their evolution by August to December 2020. METHODS: We conducted an environmental scan of family presence policies and restrictions in all 19 Canadian PICUs using 2 methods. We conducted a literature review of public-facing visitation policy documents in June 2020 using a standardized data extraction form. We also administered a cross-sectional survey of PICU leadership (managers and physician chiefs) between August and December 2020 by telephone or videoconferencing. We used inductive content analysis to code qualitative data, generating summative count data. We analyzed quantitative data descriptively. RESULTS: As part of the literature search, we collected 2 (12%) PICU-specific, 14 (82%) pediatric-specific and 1 (6%) hospital-wide visitation policy documents from the early pandemic. One policy document provided guidance on all of the policy elements sought; the number of enabled caregivers was not included in the documents for 7 of 19 units (37%). All 19 Canadian PICUs were represented among the 24 survey respondents (15 physician chiefs and 9 operations or clinical managers). Before the COVID-19 pandemic, all units allowed the presence of 2 or more family members. Early in the pandemic, reported practices limited the number of adult caregivers for patients without SARS-CoV-2 infection to 1 (n = 21/24, 88%) or 2 (n = 3/24, 12%); all units prohibited siblings. Some centres restricted caregivers from switching bedside presence with one another (patients without SARS-CoV-2 infection: n = 16/23, 70%; patients with confirmed or suspected SARS-CoV-2 infection: n = 20/23, 87%); leaving their child's PICU room (patients without SARS-CoV-2 infection: n = 1/24, 4%; patients with confirmed or suspected SARS-CoV-2 infection: n = 16/24, 67%); and joining in-person rounds (patients without SARS-CoV-2 infection: n = 9/22, 41%; patients with confirmed or suspected SARS-CoV-2 infection: n = 17/22, 77%). All respondents endorsed policy exceptions during end-of-life care. Some reported policies and practices were adapted over the study period. INTERPRETATION: Early COVID-19-related family presence policies in Canadian PICUs varied among centres. Although some centres adapted policies and practices, this study revealed ongoing potential threats to family centred care at the mid-pandemic stage.

Prolonged hyperglycemia in three patients with type 2 diabetes after COVID-19 infection: A case series.

Three independent cases of adult patients are described who had relative control of their type 2 diabetes prior to infection with COVID-19. Each of the described patients had different levels of severity of COVID-19 but all experienced significant and prolonged hyperglycemia for at least 1-2 months after resolution of their COVID-19 infection. Two of the three patients required intensifying insulin regimens for two months after COVID-19 infection. The case study helps to inform primary care providers about the possible need for the intensification of antihyperglycemic medications for several weeks to months after the resolution of COVID-19 infection to minimize prolonged hyperglycemia.

The Impact of Eliminating Backward Navigation on Computerized Examination Scores and Completion Time

[...]the decision was made to restrict backward navigation, these two potential negative impacts were identified by both faculty members and students as undesirable. Because of the lack of sufficient literature to determine whether these potential negative impacts occur, this evaluation was developed to monitor both change in score on identical questions and the time to complete the examination. While new lecturers were rare in the courses studied, in all instances, these instructors created new examination questions. [...]none of these questions would have been included in our primary analysis of identical questions from year to year. The same content was divided into three examinations for the 2019 year. Because the 2019 examination questions were included in the first two examinations given during the 2018 year, a direct comparison of overall examination time and total examination score is not possible. Four of the six mean examination scores were slightly lower after eliminating backward navigation;however, none of the changes were significant. Because there was only one identical true/ false question on all six examinations combined, no analysis could be done based on question type.